Umpqua Health is a Coordinated Care Organization (CCO) in Roseburg, Oregon that serves over 30,000 OHP members within Douglas County, offering benefits, programs and outreach for those in need. Currently we are seeking a Case Manager, to join our Medical Management team.

• Full-time position in Roseburg, OR.
• Generous benefit package including; PTO, Health, Vision and Dental Insurance, 401k with a company match, gym membership reimbursement and more.
• Starting salary at $60,000. Annual Salary will be determined based upon experience.

The Case Managers (CM) are responsible for helping those with chronic illness, mental health issues or life-altering conditions to gain access to rehabilitation programs and other community services. A CM provides support to the Oregon Health Plan (OHP) enrollees and Medicare members. The CM will adhere to regulatory compliance requirements and provide exceptional customer service to all internal and external customers.
Essential Job Responsibilities:

• Meets with clients and their families, connecting clients with professional services and maintaining consistent communication, assessing their wellbeing and making changes to treatment plans as needed.
• Recording clients progress including charting referrals, home visits and other notable interactions.
• Evaluating clients progress periodically and adjusting as needed to improve outcomes.
• Follow-up with discharged clients to ensure they were satisfied with services and are still in good physical and mental health.
• Perform member screenings using a variety of assessment tools, information gathered from interviewing client and/or other professionals and established clinical guidelines to determine the appropriate referral(s).
• Respond to program inquiries, conduct intakes and assess eligibility for program services as clients prepare to enter services
• Gather appropriate consents from members to use in gathering information from outside agencies/sources.
• Conduct needs assessment to ensure access to internal programs as well as outside community partners.
• Provide care coordination support and coaching for clients, including support for obtaining employment and housing, through resume building, finding employment, and Social Security applications.
• Coordinate emergency assistance for eligible clients by communicating with clients and vendors, collecting and completing necessary paperwork and vouchers, and submitting requests for Flexible Spending to accounting department; Follow-up with clients as necessary.
• Provide information and referral services as needed.
• Meet with clients to provide high-quality and culturally specific assessment, information and referral, readiness mapping for services.
• Serve as a liaison to agency programs and community partners with the purpose of screening for readiness of financial empowerment services.
• Assist as necessary with scheduling of services, and contacting community partners, if outside referral is appropriate.
• Provide outreach services.
• Maintain updated knowledge of the Oregon Administrative Rules (OAR) governing OHP. Remains current on Medicare guidelines and the appeals and grievance process and the members’ rights and responsibilities as stated by the Division of Medical Assistance Program (DMAP aka HSD) Oregon Health Authority (OHA) and Centers for Medicare and Medicaid Services (CMS.)
• Demonstrates an on-going understanding and current knowledge of benefits for Medicare and Medicaid populations.
• Actively engage with members meeting them in a variety of locations comfortable to the patient to discuss and assist with care. This may be an in-home visit, or a local community location.
• Advocate and navigate within the health care system and community to assist the member with care.
• Maintain electronic records of clients receiving navigation services and document in appropriate systems for notes of coordination and patient needs.

Qualifications:

• Bachelor’s Degree in Behavioral Science, social science or related field or Licensed RN, LCSW, PharmD or RT and 2 years of experience.
• Must be a Certified Case Manager (CCM).
• Must complete a Certified Community Health Worker (CHW) Supervisor training course.
• Knowledge of medical terminology, procedure codes and diagnosis codes.
• Clinical knowledge of the health or social work needs for the population served.
• Must have a driver's license, access to vehicle and ability to obtain automobile insurance at levels required by agency.

For more information or to apply visit our website at www.umpquahealthcareers.com

Job Type: Full-time

Pay: $60,000.00 per year

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